PB2084: FIRST-LINE TREATMENT IN ADVANCED STAGE FOLICULAR LYMPHOMA: A SINGLE-CENTER EXPERIENCE WITH R-CHOP VS BENDAMUSTINE-RITUXIMAB.
Authors: O. Mompel, C. Amorós, P. López-Menargues, C. Játiva, A. Cámara, R. García-Serra, M. J. Lis, M. T. Orero, S. Ortiz, M. Linares
Journal: HemaSphere (2022)

Background: R-CHOP and bendamustine-rituximab (B-R) have been the most widely used induction regimens in recent years in advanced-stage follicular lymphoma (FL). B-R in comparison with R-CHOP has shown in 2 randomized studies a higher rate of complete remissions and better progression-free survival (PFS) in one of them, although without improving overall survival (OS). Aims: To review our experience and compare the efficacy of R-CHOP vs B-R in advanced-stage FL. Methods: We reviewed the medical records of 92 patients diagnosed in our hospital with advanced-stage FL, who had received R-CHOP or B-R as first-line treatment between June 2005 and June 2021. We assessed the clinical and biological data at diagnosis, including FL International Prognostic index (FLIPI), response to induction treatment, incidence of major infectious events requiring hospitalization, PFS and OS. Quantitative variables were compared with Mann-Withney U-test and qualitative variables using Chi-square or Fisher’s exact tests. Survival was calculated using Kaplan-Meier and the differences between groups were studied using the Log-rank test. Results: No differences were observed as per the variables with prognostic influence between the two groups, and although age was higher in the BR group, the differences were not significant, neither the risk distribution according to FLIPI. We observed a high response rate with both regimens, with a slightly higher percentage of complete responses with B-R, yet the differences were not significant (Table). Regarding the number of admissions for infection during treatment, it was higher in patients treated with R-CHOP although there were no significant differences (Table). With a median follow-up of 62 months, no significant differences were observed in OS between the two regimens, and median survival was not achieved in neither group (see Table and Figure). As for PFS, no differences were observed between the two regimens (Table and Figure). When patients older than 60 years were analyzed separately (44 patients), no significant differences were observed in PFS and OS, as in the complete series of patients (data not shown). 8 patients received rituximab maintenance after B-R (44%), and 48 patients following R-CHOP (64,95%). Only 2 patients in each treatment group underwent high-dose therapy followed by autologous stem-cell transplantation (ASCT). - R-CHOP (74 patients) B-R(18 patients) p Responses CR 57 (77%)PR 14 (18,9%)NR 2 (2,7%)Not evaluated 1 CR 15 (83,3%)PR (16,7%) 0,839 Admission due to infectious events 13 (17,6%) 2 (11,1%) 0,398 PFS 127 months Median not achieved 0,790 At 2 years: 88,1% At 2 years: 82,1% At 5 years: 73,9% At 5 years: 74,4% OS Median not achieved Median not achieved 0,544 At 2 years: 90,2% At 2 years: 86,5% At 5 years: 86,9% At 5 years: 76,9% Image:Summary/Conclusion: Our experience does not demonstrate greater efficacy regarding depth of response neither in PFS with the B-R regimen in comparison with R-CHOP as has been previously reported, although it must be considered that the limited number of patients included may have influenced these results. Regarding the similarity in OS with both regimes, our study confirms the findings observed in previous studies. Hence, based on our experience, both regimens are a valid option for the treatment of patients with advanced-stage FL. However, given the higher incidence of admissions due to infectious events in patients treated with R-CHOP, we consider the use of B-R seems to be a preferable option for patients with greater frailty and susceptibility to infection.